Emergency Department Management of Children With Tracheostomies, Feeding Tubes, and Cerebrospinal Fluid Shunts

Enlarge Image
Delivery Method:	Online
$99.00 ADD TO CART OR SUBSCRIBE AND SAVE Back To Store

Publication Date: March 2026 (Volume 23, Number 3)

CME Credits: 4 AMA PRA Category 1 Credits™, 4 ACEP Category I Credits, 4 AAP Prescribed Credits, 4 AOA Category 2-B Credits. CME expires 03/01/2029.

Authors

Peer Reviewers

Abstract

Children with medical complexity represent a growing population in emergency medicine, and many of these children depend on medical technology. This issue provides an evidence-based framework for the emergency management of children with 3 commonly encountered technologies: tracheostomies, enteral feeding tubes, and cerebrospinal fluid shunts. Distinct risks, including obstruction, dislodgement, infection, and mechanical failure, are discussed. Strategies for early recognition, stabilization, and incorporation of caregiver input are reviewed to improve outcomes and reduce medical errors. By understanding technology-specific complications and emphasizing collaborative care, emergency clinicians can deliver safer, more effective treatment for this high-risk pediatric population.

Case Presentations

A 2-year-old boy in respiratory distress is brought in by EMS...

• The boy was born at 27 weeks’ gestation. He has cerebral palsy and developmental delay. He is dependent on a gastrostomy tube, tracheostomy, and a home ventilator. His parents called EMS with concern for respiratory distress and increased oxygen requirement on his ventilator. They first noticed a minor increase in his tracheostomy secretions a few days prior to presentation, but he was otherwise at his baseline until he became febrile yesterday afternoon. Today, the patient continues to have fever of 38°C, and his parents noticed increased and thicker tracheostomy secretions, an increase in his baseline retractions, and desaturations requiring increased oxygen on his ventilator.
• The boy’s vital sign are: temperature, 38.2°C; heart rate, 135 beats/min; blood pressure, 85/40 mm Hg; respiratory rate, 32 breaths/min; and oxygen saturation, 95%. His tracheostomy tube is in place, with thick yellow secretions. He has intercostal retractions and a soft abdomen.

How should you approach the workup for this patient?

• A 16-month-old girl with a history of autism, epilepsy, and gastrostomy tube dependence presents with vomiting and intolerance of gastrostomy tube feeds...
• The girl’s mother reports that symptoms started 2 days ago with 1 to 2 episodes of nonbloody, nonbilious emesis per day. Today, she was unable to tolerate any of her gastrostomy tube feeds, so her mother brought her in. The mother tells you that the emesis has remained nonbloody and nonbilious. The girl has had 3 wet diapers so far today, and her last bowel movement was yesterday and was normal.
• The patient’s vital signs are unremarkable. On examination, her abdomen is soft. Her gastrostomy tube site is clean, dry, and intact. Her capillary refill time is 2 to 3 seconds. A point-of-care glucose reading is 82 mg/dL.
• What is the differential diagnosis for this presentation?

A 7-year-old boy with a history of congenital hydrocephalus with a ventriculoperitoneal shunt was brought in by his parents for worsening headache and vomiting…

• The patient woke up this morning with a headache that has progressively worsened in severity, and this afternoon he had 2 episodes of nonbloody, nonbilious emesis. Upon arrival, the parents noted he was difficult to arouse.
• On examination, the boy’s vital signs are: temperature, 37°C; heart rate, 95 beats/min; blood pressure, 85/44 mm Hg; respiratory rate, 22 breaths/min; and oxygen saturation, 98%. He has a Glasgow Coma Scale score of 10. He opens his eyes and localizes to pain. His pupils are equal, round, and reactive to light. During the examination, he is not speaking with appropriate words.
• What imaging modality would be most helpful in establishing a diagnosis for this patient?

Accreditation:

EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.